Josh Allen in concussion protocol: Update cleared 10/5

[PromoTheRobot]

3 minutes ago, london_bills said:

Why didn't any player stand up to the player that layed the hit to Allen.

 

Because they didn't want to negate the personal foul penalty, not realizing it was already negated by the holding call. I was at the game and saw Bills players pulling back their own teammates.

[Boatdrinks]

11 minutes ago, Kelly the Dog said:

Trent always checked down, before and after the hit. He did it all the time in college, too, because his line was awful and he got battered in the pocket.

Yep, the guy took zero risks. Not in his game; Allen is just the opposite. 

1 hour ago, Saint Doug said:

I think that was just Trent. In the Kelly-Marino generation, I’m sure QBs used to sustain concussions at a similar frequency as now. As players, they turned out just fine. 

Way more common in Kelly - Marino era. Many of the hits they took are no longer legal by rule. There wasn’t a “ strike zone” for QBs and defenders helmets would hit them in the chinstrap. Totally different game then. 

[DrPJax]

9 hours ago, njbuff said:

How does anyone who has a concussion be able to sprint into the locker room?

 

Baffling to me.

I am just writing this for information and not to be a smart a**.  I am a board certified family practice and er dr with over 33 years in practice so I am giving you accurate info. There are well known cases of people surviving terrible traumatic things like car accidents and they miraculously get up and walk away from the scene, only to drop over unconscious or dead several hours later. The first 24 - 48:hours are a critical time for observation after a trauma , especially one where the person has lost consciousness. It’s why even after being cleared to go home after being seen in an er that every patient is discharged with the written instructions for for them and family listing symptoms to look for and why it’s necessary to immediately return to the er if things such as nausea or vomiting recur. Bleeding into the brain or around it into the closed space of the skull can have delayed symptoms and brain herniation can result with the patient dying. Even ct scans can miss a delayed  bleed so no initial screening test is infallible. Look up subdural hemorrhage or sub arachnoid bleed for explanations of this scenario. So yes, it’s possible to easily get up and jog immediately after a very serious brain injury only to succumb later. That’s not the “ typical “ presentation , but medicine is anything but typical.  Hope that helps .?

[jkeerie]

2 minutes ago, DrPJax said:

I am just writing this for information and not to be a smart a**.  I am a board certified family practice and er dr with over 33 years in practice so I am giving you accurate info. There are well known cases of people surviving terrible traumatic things like car accidents and they miraculously get up and walk away from the scene, only to drop over unconscious or dead several hours later. The first 24 - 48:hours are a critical time for observation after a trauma , especially one where the person has lost consciousness. It’s why even after being cleared to go home after being seen in an er that every patient is discharged with the written instructions for for them and family listing symptoms to look for and why it’s necessary to immediately return to the er if things such as nausea or vomiting recur. Bleeding into the brain or around it into the closed space of the skull can have delayed symptoms and brain herniation can result with the patient dying. Even ct scans can miss a delayed  bleed so no initial screening test is infallible. Look up subdural hemorrhage or sub arachnoid bleed for explanations of this scenario. So yes, it’s possible to easily get up and jog immediately after a very serious brain injury only to succumb later. That’s not the “ typical “ presentation , but medicine is anything but typical.  Hope that helps .?

Thank you for this.  Very informative. 

[Pine Barrens Mafia]

7 minutes ago, DrPJax said:

I am just writing this for information and not to be a smart a**.  I am a board certified family practice and er dr with over 33 years in practice so I am giving you accurate info. There are well known cases of people surviving terrible traumatic things like car accidents and they miraculously get up and walk away from the scene, only to drop over unconscious or dead several hours later. The first 24 - 48:hours are a critical time for observation after a trauma , especially one where the person has lost consciousness. It’s why even after being cleared to go home after being seen in an er that every patient is discharged with the written instructions for for them and family listing symptoms to look for and why it’s necessary to immediately return to the er if things such as nausea or vomiting recur. Bleeding into the brain or around it into the closed space of the skull can have delayed symptoms and brain herniation can result with the patient dying. Even ct scans can miss a delayed  bleed so no initial screening test is infallible. Look up subdural hemorrhage or sub arachnoid bleed for explanations of this scenario. So yes, it’s possible to easily get up and jog immediately after a very serious brain injury only to succumb later. That’s not the “ typical “ presentation , but medicine is anything but typical.  Hope that helps .?

 

That's way too intelligent for these parts.

 

Please don't stop posting.

 

[Gugny]

19 minutes ago, PromoTheRobot said:

 

Because they didn't want to negate the personal foul penalty, not realizing it was already negated by the holding call. I was at the game and saw Bills players pulling back their own teammates.

 

Why were you not at Hammer's in the TBD area???

[The Frankish Reich]

9 minutes ago, DrPJax said:

I am just writing this for information and not to be a smart a**.  I am a board certified family practice and er dr with over 33 years in practice so I am giving you accurate info. There are well known cases of people surviving terrible traumatic things like car accidents and they miraculously get up and walk away from the scene, only to drop over unconscious or dead several hours later. The first 24 - 48:hours are a critical time for observation after a trauma , especially one where the person has lost consciousness. It’s why even after being cleared to go home after being seen in an er that every patient is discharged with the written instructions for for them and family listing symptoms to look for and why it’s necessary to immediately return to the er if things such as nausea or vomiting recur. Bleeding into the brain or around it into the closed space of the skull can have delayed symptoms and brain herniation can result with the patient dying. Even ct scans can miss a delayed  bleed so no initial screening test is infallible. Look up subdural hemorrhage or sub arachnoid bleed for explanations of this scenario. So yes, it’s possible to easily get up and jog immediately after a very serious brain injury only to succumb later. That’s not the “ typical “ presentation , but medicine is anything but typical.  Hope that helps .?

Same here. Thanks! Anecdotally, I'm aware of several cases of people who took a blow to the head/suffered a fall, walked away seemingly o.k., and then had severe symptoms after the fact.   Here's just one that pops up often:  https://people.com/celebrity/natasha-richardson-tragic-delays-after-her-fatal-fall/

[KC22]

Take it for what it's worth, but when I was a senior in high school playing travel baseball @ Sal Maglie, I was playing right field, sprinted up to catch a pop fly, dove... well so did the shortstop ?  he dislocated his elbow on the back of my head which knocked me unconscious for a couple minutes. Only time I've been knocked out and when I woke up it felt like waking up from a ten hour sleep.

 

Obviously had to go to the hospital to get checked out, they wouldnt let me sit up for 3 hours until I got a cat scan even though I felt fine. They stapled my head shut and sent me home with a concussion, because I guess if you get knocked out its automatically considered one. 

 

Never had one symptom afterwards and felt completely fine.

 

So seeing Josh get his sh*t scrambled and having the twitches was pretty scary to see, but seeing him up so quick after and running on his own just ten minutes later makes me think he'll be okay sooner than later.

[Coach Tuesday]

3 minutes ago, KC22 said:

Take it for what it's worth, but when I was a senior in high school playing travel baseball @ Sal Maglie, I was playing right field, sprinted up to catch a pop fly, dove... well so did the shortstop ?  he dislocated his elbow on the back of my head which knocked me unconscious for a couple minutes. Only time I've been knocked out and when I woke up it felt like waking up from a ten hour sleep.

 

Obviously had to go to the hospital to get checked out, they wouldnt let me sit up for 3 hours until I got a cat scan even though I felt fine. They stapled my head shut and sent me home with a concussion, because I guess if you get knocked out its automatically considered one. 

 

Never had one symptom afterwards and felt completely fine.

 

So seeing Josh get his sh*t scrambled and having the twitches was pretty scary to see, but seeing him up so quick after and running on his own just ten minutes later makes me think he'll be okay sooner than later.

You realize you’ve been posting that same exact post here every day for the past sixteen years? 

[Mojo44]

 I have evaluated many patients with traumatic brain injuries over the years, mostly veterans. Loss of consciousness is a grade one symptom. If someone loses consciousness after getting hit on the head a full-fledged concussion protocol should be initiated. They did the right thing with you and with Josh. Although I’m not completely certain he fully lost consciousness but he might have

[BillsFanM.D.]

45 minutes ago, DrPJax said:

I am just writing this for information and not to be a smart a**.  I am a board certified family practice and er dr with over 33 years in practice so I am giving you accurate info. There are well known cases of people surviving terrible traumatic things like car accidents and they miraculously get up and walk away from the scene, only to drop over unconscious or dead several hours later. The first 24 - 48:hours are a critical time for observation after a trauma , especially one where the person has lost consciousness. It’s why even after being cleared to go home after being seen in an er that every patient is discharged with the written instructions for for them and family listing symptoms to look for and why it’s necessary to immediately return to the er if things such as nausea or vomiting recur. Bleeding into the brain or around it into the closed space of the skull can have delayed symptoms and brain herniation can result with the patient dying. Even ct scans can miss a delayed  bleed so no initial screening test is infallible. Look up subdural hemorrhage or sub arachnoid bleed for explanations of this scenario. So yes, it’s possible to easily get up and jog immediately after a very serious brain injury only to succumb later. That’s not the “ typical “ presentation , but medicine is anything but typical.  Hope that helps .?

 

Preach it!  I'll second the accuracy.  Equally (if not more so) disturbing are the epidural hematomas.  That would be very atypical for the type of trauma/headgear involved here....but it reinforces the fact that just because 'everything looks ok at first' doesn't mean it's going to stay that way.  

[Buffalo716]

55 minutes ago, DrPJax said:

I am just writing this for information and not to be a smart a**.  I am a board certified family practice and er dr with over 33 years in practice so I am giving you accurate info. There are well known cases of people surviving terrible traumatic things like car accidents and they miraculously get up and walk away from the scene, only to drop over unconscious or dead several hours later. The first 24 - 48:hours are a critical time for observation after a trauma , especially one where the person has lost consciousness. It’s why even after being cleared to go home after being seen in an er that every patient is discharged with the written instructions for for them and family listing symptoms to look for and why it’s necessary to immediately return to the er if things such as nausea or vomiting recur. Bleeding into the brain or around it into the closed space of the skull can have delayed symptoms and brain herniation can result with the patient dying. Even ct scans can miss a delayed  bleed so no initial screening test is infallible. Look up subdural hemorrhage or sub arachnoid bleed for explanations of this scenario. So yes, it’s possible to easily get up and jog immediately after a very serious brain injury only to succumb later. That’s not the “ typical “ presentation , but medicine is anything but typical.  Hope that helps .?

Yes good info but nobody knows that Allen lost consciousness

 

That's huge information that McDermott nor the team has said

[EmotionallyUnstable]

I’m also a doctor and I think he is fine. 

[DrPJax]

4 minutes ago, BillsFanM.D. said:

 

Preach it!  I'll second the accuracy.  Equally (if not more so) disturbing are the epidural hematomas.  That would be very atypical for the type of trauma/headgear involved here....but it reinforces the fact that just because 'everything looks ok at first' doesn't mean it's going to stay that way.  

Great point about the epidural hematoma. Nice to meet another Md bills fan in the board!  I have been a bills fan since 63 , born and raised in Ohio but moved to Jax after residency / meds school in Toledo in 1985. Been on the board a long time and have met some wonderful people on here. Don’t post a lot as over the years the environment has gotten “ less supportive “ , as people become very negative and critical surprisingly on an opinion based format. Hard to figure why people attack each other and heaven forbid if you are critical of the performance despite the result. It’s like am Md who is still practicing despite multiple malpractice cases; an md but doesn’t mean his practice is sustainable and that he/ she will be ok despite repeating the same mental errors!  Lol!  Three of our 4 wins have been “ malpractice “  with performance and I just hope Allen can get past being a resident to become a full outstanding attending! ?

What type of medicine are you in?  How are things going for you and your career in today’s environment?  Corporate medicine took over in my lifetime ( I am 62 now ) and it took so much enjoyment out of everything I love about medicine. Still would not change being in the greatest profession and all the amazing people who allowed me in their lives because of it. I have been exiled into just being a malpractice consultant now as 3 years ago I had 4 discs collapse in my cervical spine without much warning ( was walking down the hall seeing patients when my leg gave out and I fell against the wall) .  Had urgent 4 level anterior decompression but my cord  was permanently damaged and I have no feeling in either upper extremity , some muscle wasting , upper motor neuron hyperreflexia in my legs , and it knocked me out of seeing patients safely. I miss that part so much despite all the management changes with insurance etc   Well forgive the long note, just nice to see a colleague and fellow Bills fanatic on here. Wishing you the best and much enjoyment of the season ! 

[Turk71]

30 minutes ago, Buffalo716 said:

Yes good info but nobody knows that Allen lost consciousness

 

That's huge information that McDermott nor the team has said

I have no way of knowing but he looked knocked out to me. Offsetting penalties, no ejection, no suspension; why don't they just knock out every starting QB they play.

  An uncalled face mask right in front of the ref while Allen was about to escape the rush, Gilmore grabbing John Brown's face as he was about to be wide open over the middle, the flag was thrown and then inexplicably picked up. That game was total bull####. The Bills didn't help themselves by scrambling out of fg range and all the turnovers but NE didn't do anything on offense but got enough help from the Bills and the refs to win. That game sucked.

Edited October 1, 2019 by Turk71

[oldmanfan]

The last few posts here are kind of a microcosm of how messed up chat rooms can get.  A physician who deals with head injuries offers educated medical opinion on the hit Allen took yesterday and I see some arguing.  

 

I teach anatomy and physiology and I wouldn’t argue with him.  All I know is the moment he got hit he was down and not moving and players were immediately waving for the medical staff.  That would suggest it was a pretty bad shot to the head.

Edited October 1, 2019 by oldmanfan

[Buffalo716]

1 minute ago, Turk71 said:

I have no way of knowing but he looked knocked out to me. Offsetting penalties, no ejection, no suspension; why don't they just knock out every starting QB we play.

  An uncalled face mask right in front of the ref while Allen was about to escape the rush, Gilmore grabbing John Brown's face as he was about to be wide open over the middle, the flag was thrown and then inexplicably picked up. That game was total bull####. The Bills didn't help themselves by scrambling out of fg range and all the turnovers but NE didn't do anything on offense but got enough help from the Bills and the refs to win. That game sucked.

He was cracked and I was like o **** but he was wiggling his leg around and looked like he tried propping himself up but teammates held him down

[DrPJax]

30 minutes ago, Buffalo716 said:

Yes good info but nobody knows that Allen lost consciousness

 

That's huge information that McDermott nor the team has said

Just my opinion from seeing him unresponsive on the field. I was not there obviously but he immediately quit moving and the players around him signaled for help I believe. Just an educated opinion, and given that he didn’t return I am betting he lost consciousness for at least some brief period. Doesn’t meant he is not fine or won’t be , just that it explains why he didn’t return immediately. I’m sure given his past history being negative for multiple concussions as far as I am aware that he will be return quickly. I hope so because I love watching him!  

[BillsFanM.D.]

2 minutes ago, DrPJax said:

Great point about the epidural hematoma. Nice to meet another Md bills fan in the board!  I have been a bills fan since 63 , born and raised in Ohio but moved to Jax after residency / meds school in Toledo in 1985. Been on the board a long time and have met some wonderful people on here. Don’t post a lot as over the years the environment has gotten “ less supportive “ , as people become very negative and critical surprisingly on an opinion based format. Hard to figure why people attack each other and heaven forbid if you are critical of the performance despite the result. It’s like am Md who is still practicing despite multiple malpractice cases; an md but doesn’t mean his practice is sustainable and that he/ she will be ok despite repeating the same mental errors!  Lol!  Three of our 4 wins have been “ malpractice “  with performance and I just hope Allen can get past being a resident to become a full outstanding attending! ?

What type of medicine are you in?  How are things going for you and your career in today’s environment?  Corporate medicine took over in my lifetime ( I am 62 now ) and it took so much enjoyment out of everything I love about medicine. Still would not change being in the greatest profession and all the amazing people who allowed me in their lives because of it. I have been exiled into just being a malpractice consultant now as 3 years ago I had 4 discs collapse in my cervical spine without much warning ( was walking down the hall seeing patients when my leg gave out and I fell against the wall) .  Had urgent 4 level anterior decompression but my cord  was permanently damaged and I have no feeling in either upper extremity , some muscle wasting , upper motor neuron hyperreflexia in my legs , and it knocked me out of seeing patients safely. I miss that part so much despite all the management changes with insurance etc   Well forgive the long note, just nice to see a colleague and fellow Bills fanatic on here. Wishing you the best and much enjoyment of the season ! 

 

LOL on the analogy!  

I'm FP by training as well.  Did inpt/outpatient for about 15 years and am now part of a large multi specialty group and Vice Chief of staff at a hospital.  I'm over 20 years in as well. Definitely more of an administrative role at this point but I still see patients.  I, like you, seem to love medicine but I'm not such a big fan of health care.  There is a huge distinction there that most people seemingly overlook.  That's a crazy story about your neck!  4 levels!!  Yikes.  Glad you are still able to find a role that uses your education.  

 

I've been a Bills fan forever....at least in my head.  Born in 71 and loved them since I can remember.  I also lurk here most than post but I jump in periodically.  

 

Enjoy the season!!  Go Bills!!!!!!!

[Buffalo716]

8 minutes ago, DrPJax said:

Just my opinion from seeing him unresponsive on the field. I was not there obviously but he immediately quit moving and the players around him signaled for help I believe. Just an educated opinion, and given that he didn’t return I am betting he lost consciousness for at least some brief period. Doesn’t meant he is not fine or won’t be , just that it explains why he didn’t return immediately. I’m sure given his past history being negative for multiple concussions as far as I am aware that he will be return quickly. I hope so because I love watching him!  

Thanks for your opinion

 

But when Allen hits the ground he does roll his knee around in pain for a while suggesting to me he was still conscious just in extreme agony... He was moving his knee around

Edited October 1, 2019 by Buffalo716

[TheFunPolice]

This might be a dumb question, but after a concussion is suffered, what has to "heal" for you to feel better?

 

Isn't the brain like pudding?

Edited October 1, 2019 by TheFunPolice

[YoloinOhio]

1 minute ago, TheFunPolice said:

This might be a dumb question, but after a concussion is suffered, what has to "heal" for you to feel better?

 

Isn't the brain like pudding?

They have to determine that he’s back to the baseline cognitive functions, which are recorded for each player in the preseason. If they do then they can start light activity and then football activity but any setbacks and they start over. 

[oldmanfan]

2 minutes ago, TheFunPolice said:

This might be a dumb question, but after a concussion is suffered, what has to "heal" for you to feel better?

 

Isn't the brain like pudding?

No.  The brain is living tissue with cells, blood supply, etc.  Concussion can affect and damage those so healing has to take place.

[Speedy Beebe]

2 hours ago, PromoTheRobot said:

 

Because they didn't want to negate the personal foul penalty, not realizing it was already negated by the holding call. I was at the game and saw Bills players pulling back their own teammates.

I could be wrong but I thought that I saw Ford go up to him but teammates corralled him back.

[TheFunPolice]

So is it blood vessels in the head? I thought brains didn't heal

[YoloinOhio]

3 minutes ago, Speedy Beebe said:

I could be wrong but I thought that I saw Ford go up to him but teammates corralled him back.

Yep it was Ford, the broadcast thought he was going to be flagged 

[RiotAct]

17 minutes ago, YoloinOhio said:

They have to determine that he’s back to the baseline cognitive functions, which are recorded for each player in the preseason. If they do then they can start light activity and then football activity but any setbacks and they start over. 

“Alright Josh, can you tell me where the free safety is?”

 

?

[DrPJax]

3 minutes ago, TheFunPolice said:

This might be a dumb question, but after a concussion is suffered, what has to "heal" for you to feel better?

 

Isn't the brain like pudding?

Great question, not dumb at all!  Just imagine any bruise you have had in the past anywhere on the body. There is some leaking of fluid from damaged small blood vessels in the area of trauma. The bruise you see is actually from the breakdown of hemoglobin from red blood cells that have been leaked into the surrounding tissue in the area of trauma. Fluid leaks out of the blood Vessels as well ( fluid is predominantly within,the vessels as part of normal circulation ) and as the fluid leaks swelling occurs. The brain is somewhat unique because it sits on a closed space , the skull , and has little tolerance for the swelling as opposed to other non- closed areas of the body. As swelling occurs pressure increases. This presses on small neurons and causes them to have difficulty sending their electrical impulses or signals. Also the swelling compromises oxygen supply to Neurons and brain cells and which contributes to cells not firing like normally.  Symptoms like headaches, nausea , vomiting , confusion can develop in the area because of the cells not working normally. As time goes on and the blood vessels stop leaking and inflammation from the immune response subsides , the fluid is reabsorbed and normal pressure is reestablished and oxygen content returns to normal. Think of how a bruise color fades on your skin over time as the damaged red blood cells are broken down  and the swelling goes away. When this happens in the brain normal cell and neuron function returns and symptoms get better. So as edema , swelling fades , brain function and how you feel return to normal. Simplified explanation but I hope it helps. ?

[CincyBillsFan]

Question for the docs posting, and thanks for sharing your expertise it's much appreciated.  What should we conclude, if anything,  by Allen running off the field to the locker room?  I would have thought if he was still "loopy" they would have had a trainer escort him rather then let him go on his own.  Should we be more or less hopeful that this was a minor concussion?

 

 

[PromoTheRobot]

16 hours ago, Gugny said:

 

Why were you not at Hammer's in the TBD area???

 

Because I had to be able to get out of Dodge quickly after the game. If I parked at Hammer's I'd be stuck in traffic longer. There's a lot on Southwestern that you can get of out fast. But I'm in for the Eagles and will park at Hammer's that game.

Edited October 1, 2019 by PromoTheRobot

[Bangarang]

7 minutes ago, DrPJax said:

Great question, not dumb at all!  Just imagine any bruise you have had in the past anywhere on the body. There is some leaking of fluid from damaged small blood vessels in the area of trauma. The bruise you see is actually from the breakdown of hemoglobin from red blood cells that have been leaked into the surrounding tissue in the area of trauma. Fluid leaks out of the blood Vessels as well ( fluid is predominantly within,the vessels as part of normal circulation ) and as the fluid leaks swelling occurs. The brain is somewhat unique because it sits on a closed space , the skull , and has little tolerance for the swelling as opposed to other non- closed areas of the body. As swelling occurs pressure increases. This presses on small neurons and causes them to have difficulty sending their electrical impulses or signals. Also the swelling compromises oxygen supply to Neurons and brain cells and which contributes to cells not firing like normally.  Symptoms like headaches, nausea , vomiting , confusion can develop in the area because of the cells not working normally. As time goes on and the blood vessels stop leaking and inflammation from the immune response subsides , the fluid is reabsorbed and normal pressure is reestablished and oxygen content returns to normal. Think of how a bruise color fades on your skin over time as the damaged red blood cells are broken down  and the swelling goes away. When this happens in the brain normal cell and neuron function returns and symptoms get better. So as edema , swelling fades , brain function and how you feel return to normal. Simplified explanation but I hope it helps. ?

[BillsFanM.D.]

1 minute ago, CincyBillsFan said:

Question for the docs posting, and thanks for sharing your expertise it's much appreciated.  What should we conclude, if anything,  by Allen running off the field to the locker room?  I would have thought if he was still "loopy" they would have had a trainer escort him rather then let him go on his own.  Should we be more or less hopeful that this was a minor concussion?

 

 

 

I don't think you can read much into it at all.  As noted, it's hard to predict how one might feel 30 or 60 minutes or a few days later.  Having said that, some common sense enters the equation:  Were he completely goofy and unsteady on his feet.....requiring assistance or even a cart to get to the locker room, I would not be terribly optimistic.  Every data point (including how he looks/acts immediately after) is a piece of information.  I view his 'running off' as a good sign.....but not proof of anything.  Much more 'data' already in hand for the team docs and more to come.  

[TheFunPolice]

10 minutes ago, DrPJax said:

Great question, not dumb at all!  Just imagine any bruise you have had in the past anywhere on the body. There is some leaking of fluid from damaged small blood vessels in the area of trauma. The bruise you see is actually from the breakdown of hemoglobin from red blood cells that have been leaked into the surrounding tissue in the area of trauma. Fluid leaks out of the blood Vessels as well ( fluid is predominantly within,the vessels as part of normal circulation ) and as the fluid leaks swelling occurs. The brain is somewhat unique because it sits on a closed space , the skull , and has little tolerance for the swelling as opposed to other non- closed areas of the body. As swelling occurs pressure increases. This presses on small neurons and causes them to have difficulty sending their electrical impulses or signals. Also the swelling compromises oxygen supply to Neurons and brain cells and which contributes to cells not firing like normally.  Symptoms like headaches, nausea , vomiting , confusion can develop in the area because of the cells not working normally. As time goes on and the blood vessels stop leaking and inflammation from the immune response subsides , the fluid is reabsorbed and normal pressure is reestablished and oxygen content returns to normal. Think of how a bruise color fades on your skin over time as the damaged red blood cells are broken down  and the swelling goes away. When this happens in the brain normal cell and neuron function returns and symptoms get better. So as edema , swelling fades , brain function and how you feel return to normal. Simplified explanation but I hope it helps. ?

Thank you! That makes a lot of sense.

 

 

[The Dean]

12 minutes ago, DrPJax said:

Great question, not dumb at all!  Just imagine any bruise you have had in the past anywhere on the body. There is some leaking of fluid from damaged small blood vessels in the area of trauma. The bruise you see is actually from the breakdown of hemoglobin from red blood cells that have been leaked into the surrounding tissue in the area of trauma. Fluid leaks out of the blood Vessels as well ( fluid is predominantly within,the vessels as part of normal circulation ) and as the fluid leaks swelling occurs. The brain is somewhat unique because it sits on a closed space , the skull , and has little tolerance for the swelling as opposed to other non- closed areas of the body. As swelling occurs pressure increases. This presses on small neurons and causes them to have difficulty sending their electrical impulses or signals. Also the swelling compromises oxygen supply to Neurons and brain cells and which contributes to cells not firing like normally.  Symptoms like headaches, nausea , vomiting , confusion can develop in the area because of the cells not working normally. As time goes on and the blood vessels stop leaking and inflammation from the immune response subsides , the fluid is reabsorbed and normal pressure is reestablished and oxygen content returns to normal. Think of how a bruise color fades on your skin over time as the damaged red blood cells are broken down  and the swelling goes away. When this happens in the brain normal cell and neuron function returns and symptoms get better. So as edema , swelling fades , brain function and how you feel return to normal. Simplified explanation but I hope it helps. ?

 

 

Excellent explanation, Doc. Well done. 

 

So does it mean anything that Josh looked fine going into the tent and while running into the locker room? He looked so good running to the locker room, at first I thought he was running out to come back into the game. It may mean nothing at all. But as I'm completely ignorant on  the subject, wouldn't a really bad concussion (I know there are no good ones) have left more short-term side effects?

 

 

Sorry I just saw BillsFanM.D.'s answer. But maybe you can chime in anyway.

Edited October 1, 2019 by The Dean

[DrPJax]

2 minutes ago, CincyBillsFan said:

Question for the docs posting, and thanks for sharing your expertise it's much appreciated.  What should we conclude, if anything,  by Allen running off the field to the locker room?  I would have thought if he was still "loopy" they would have had a trainer escort him rather then let him go on his own.  Should we be more or less hopeful that this was a minor concussion?

 

 

I think the only thing you can conclude is that the medical staff examined him and he was alert and able to respond correctly to the brief neurological exam done on the field at the time. For example, he was able to know where he was , situation , had short term recall ( like able to repeat three random objects or names back to the examiner ), and his basic neurological exam field side was normal. This is a very basic exam and is one point in time and has to be interpreted as such. Things can change as time goes on ; doesn’t mean they will but it is possible. So think of it as a Polaroid snapshot of his function right at that moment. That’s all that can be surmised. I was a little surprised he was not accompanied by someone just for legal purposes in today’s litigious environment. On the other hand there are so many people around he was really probably never out of the view of someone on staff. Hard to imagine a scenario where he was confused enough to just run off somewhere randomly without it being caught but you usually do see a trainer at least accompanying a player after that. He is a daredevil and may have taken off before they could keep up with him ! ?

[leh-nerd skin-erd]

16 minutes ago, DrPJax said:

Great question, not dumb at all!  Just imagine any bruise you have had in the past anywhere on the body. There is some leaking of fluid from damaged small blood vessels in the area of trauma. The bruise you see is actually from the breakdown of hemoglobin from red blood cells that have been leaked into the surrounding tissue in the area of trauma. Fluid leaks out of the blood Vessels as well ( fluid is predominantly within,the vessels as part of normal circulation ) and as the fluid leaks swelling occurs. The brain is somewhat unique because it sits on a closed space , the skull , and has little tolerance for the swelling as opposed to other non- closed areas of the body. As swelling occurs pressure increases. This presses on small neurons and causes them to have difficulty sending their electrical impulses or signals. Also the swelling compromises oxygen supply to Neurons and brain cells and which contributes to cells not firing like normally.  Symptoms like headaches, nausea , vomiting , confusion can develop in the area because of the cells not working normally. As time goes on and the blood vessels stop leaking and inflammation from the immune response subsides , the fluid is reabsorbed and normal pressure is reestablished and oxygen content returns to normal. Think of how a bruise color fades on your skin over time as the damaged red blood cells are broken down  and the swelling goes away. When this happens in the brain normal cell and neuron function returns and symptoms get better. So as edema , swelling fades , brain function and how you feel return to normal. Simplified explanation but I hope it helps. ?

Nice try with your neurons and resorbtions and oxygen content.  You didn’t mention anything about a bell getting rung, sawbones. What’s your name Pretond Uradoc, MD?   

 

(Thanks for the scoop-my son was concussed in HS, scary time.)

[DrPJax]

14 minutes ago, leh-nerd skin-erd said:

Nice try with your neurons and resorbtions and oxygen content.  You didn’t mention anything about a bell getting rung, sawbones. What’s your name Pretond Uradoc, MD?   

 

(Thanks for the scoop-my son was concussed in HS, scary time.)

Yep it is scary seeing a loved one go thru a head injury. Hope your son is well and never had further episodes. Funny story   I grew up in Ohio, trio state area around Pittsburgh pa, wheeling wva, and Steubenville Ohio ( home of Dean Martin of rat pack fame ).  So I was a huge skynerd fan growing up. So moved to jacksonville, Florida after getting done with Med training in Toledo, Ohio in 1985. So one night I am in a bar and there is Leon Wilkerson , bass player of skynerd partying at the bar. Introduced myself and ended up driving him to some other places that night. Man , no wonder these guys had short life span. Anytime I ran into him he was “ partying “ and people were always Buying stuff for him at bars. Later on I met Ronnie vanzants wife who opened a bar called free bird here in Jacksonville beach. I was able to have her become a patient and got to know her over several years. Also her daughter became a  patient and her daughter  was married to the original lead guitar player of shinedown. I was lucky enough to get to know him and his wife and they were all really neat down to earth people. Got to meet some other members of the various incarnations of the band over the years and they were all talented but humble people. Just a neat thing for a small town guy like me who grew up as a fan starting in high school, only to end up being fortunate enough to give back some to them with medical advice as I got older and moved to Jax where I never expected to end up!  Life is amazing and good and I will always be a rock fan till the day I am gone. It just boggles my mind that someday I would meet the guys who played on ONE FROM THE ROAD, after I had cranked that album so many times getting psyched for the weekend to arrive in small town rural Ohio !  Love your screen name and thanks for indulging me with my trip down memory road!  Go Bills! 

 

[Buffalo Barbarian]

Can we go the college route here and just go with targeting.

 

I think Jones intentionally went after Allen's head , but even if it wasnt intentional he should have been ejected.

 

Ejection is much more likely to reduce shots like this as penalties and fines have little impact on these types of plays.

 

 

[H2o]

2 hours ago, Buffalo Barbarian said:

Can we go the college route here and just go with targeting.

 

I think Jones intentionally went after Allen's head , but even if it wasnt intentional he should have been ejected.

 

Ejection is much more likely to reduce shots like this as penalties and fines have little impact on these types of plays.

 

 

I was thinking this yesterday as well. You start kicking guys out of games and costing them checks then things might actually change. 

[fansince88]

7 hours ago, DrPJax said:

Great question, not dumb at all!  Just imagine any bruise you have had in the past anywhere on the body. There is some leaking of fluid from damaged small blood vessels in the area of trauma. The bruise you see is actually from the breakdown of hemoglobin from red blood cells that have been leaked into the surrounding tissue in the area of trauma. Fluid leaks out of the blood Vessels as well ( fluid is predominantly within,the vessels as part of normal circulation ) and as the fluid leaks swelling occurs. The brain is somewhat unique because it sits on a closed space , the skull , and has little tolerance for the swelling as opposed to other non- closed areas of the body. As swelling occurs pressure increases. This presses on small neurons and causes them to have difficulty sending their electrical impulses or signals. Also the swelling compromises oxygen supply to Neurons and brain cells and which contributes to cells not firing like normally.  Symptoms like headaches, nausea , vomiting , confusion can develop in the area because of the cells not working normally. As time goes on and the blood vessels stop leaking and inflammation from the immune response subsides , the fluid is reabsorbed and normal pressure is reestablished and oxygen content returns to normal. Think of how a bruise color fades on your skin over time as the damaged red blood cells are broken down  and the swelling goes away. When this happens in the brain normal cell and neuron function returns and symptoms get better. So as edema , swelling fades , brain function and how you feel return to normal. Simplified explanation but I hope it helps. ?

So, you don't just play a Dr on a forum I suppose?